PREDNISONE

PREDNISONE (pred'ni-sone) Apo-Prednisone , Deltasone, Meticorten, Orasone, Panasol, Prednicen-M, Sterapred, Winpred  Classifications: adrenal corticosteroid; glucocorticoid; Therapeutic: corticosteroid; glucocorticoid Pregnancy Category: C

Availability

1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg tablets; 5 mg/5 mL, 5 mg/mL solution

Action

Immediate-acting synthetic analog of hydrocortisone. Effect depends on biotransformation to prednisolone, a conversion that may be impaired in patient with liver dysfunction. Less mineralocorticoid activity than hydrocortisone, but sodium retention and potassium depletion can occur.

Therapeutic Effect

Has antiinflammatory properties.

Uses

May be used as a single agent or conjunctively with antineoplastics in cancer therapy; also used in treatment of myasthenia gravis and inflammatory conditions and as an immunosuppressant.

Contraindications

Systemic fungal infections and known hypersensitivity; cataracts; pregnancy (category C).

Cautious Use

Patients with infections; nonspecific ulcerative colitis; diverticulitis; active or latent peptic ulcer; renal insufficiency; coagulopathy; psychosis; seizure disorders; thromboembolic disease; hypertension; osteoporosis; myasthenia gravis.

Route & Dosage

Antiinflammatory Adult: PO 5–60 mg/d in single or divided doses Child: PO 0.1–0.15 mg/kg/d in single or divided doses Acute Asthma Child: PO <1 y, 1–2 mg/kg/d x 3–5 d or 10 mg q12h; 1–4 y, 20 mg q12h; 5–13 y, 30 mg q12h; >13 y, 40 mg q12h x 3–5 d

Administration

Oral

• Crush tablet and give with fluid of patient's choice if unable to swallow whole.
• Give at mealtimes or with a snack to reduce gastric irritation.
• Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury) or if a remission or disease exacerbation occurs.
• Do not abruptly stop drug. Reduce dose gradually by scheduled decrements (various regimens) to prevent withdrawal symptoms and permit adrenals to recover from drug-induced partial atrophy.

Alternate-Day Therapy (ADT) for Patient on Long-Term Therapy

• With ADT, the 48-h requirement for steroids is administered as a single dose every other morning.
• Be aware that ADT minimizes adverse effects associated with long-term treatment while maintaining the desired therapeutic effect.

Adverse Effects (≥1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI: Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine: Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis. Metabolic: Hypokalemia.

Interactions

Drug: barbiturates, phenytoin, rifampin increase steroid metabolism—increased doses of prednisone may be needed; amphotericin B, diuretics increase potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines, toxoids.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 1–2 h. Duration: 1–1.5 d. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Hypothalamus-pituitary axis suppression: 24–36 h; in urine. Half-Life: 3.5 h.

Nursing Implications

Assessment & Drug Effects

• Establish baseline and continuing data regarding BP, I&O ratio and pattern, weight, fasting blood glucose level, and sleep pattern. Start flow chart as reference for planning individualized pharmacotherapeutic patient care.
• Check and record BP during dose stabilization period at least 2 times daily. Report an ascending pattern.
• Monitor patient for evidence of HPA axis suppression during long-term therapy by determining plasma cortisol levels at weekly intervals.
• Lab tests: Obtain fasting blood glucose, serum electrolytes, and routine laboratory studies at regular intervals during long-term steroid therapy.
• Be aware that older adult patients and patients with low serum albumin are especially susceptible to adverse effects because of excess circulating free glucocorticoids.
• Be alert to signs of hypocalcemia (see Appendix F). Patients with hypocalcemia have increased requirements for pyridoxine (vitamin B₆), vitamins C and D, and folates.
• Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressive actions). Prednisone suppresses early classic signs of inflammation. When patient is on an extended therapy regimen, incidence of oral Candida infection is high. Inspect mouth daily for symptoms: white patches, black furry tongue, painful membranes and tongue.
• Monitor bone density. Compression and spontaneous fractures of long bones and vertebrae present hazards, particularly in long-term corticosteroid treatment of rheumatoid arthritis or diabetes, in immobilized patients, and older adults.
• Be aware of previous history of psychotic tendencies. Watch for changes in mood and behavior, emotional stability, sleep pattern, or psychomotor activity, especially with long-term therapy, that may signal onset of recurrence. Report symptoms to physician.
• If a patient is receiving aspirin concomitantly with a corticosteroid, salicylism may be induced when the corticosteroid dosage is decreased or discontinued.
• Be aware that long-term corticosteroid therapy is ordinarily not interrupted when patient undergoes major surgery, but dosage may be increased.
• Monitor for withdrawal syndrome (e.g., myalgia, fever, arthralgia, malaise) and hypocorticism (e.g., anorexia, vomiting, nausea, fatigue, dizziness, hypotension, hypoglycemia, myalgia, arthralgia) with abrupt discontinuation of corticosteroids after long-term therapy.

Patient & Family Education

• Take drug as prescribed and do not alter dosing regimen or stop medication without consulting physician.
• Be aware that a slight weight gain with improved appetite is expected, but after dosage is stabilized, a sudden slow but steady weight increase [2 kg (5 lb) per wk] should be reported to physician.
• Avoid or minimize alcohol and caffeine may contribute to steroid-ulcer development in long-term therapy.
• Report symptoms of GI distress to physician and do not self-medicate to find relief.
• Do not use aspirin or other OTC drugs unless they are prescribed specifically by the physician.
• Report slow healing, any vague feeling of being sick, or return of pretreatment symptoms.
• Be fastidious about personal hygiene; give special attention to foot care, and be particularly cautious about bruising or abrading the skin.
• Report persistent backache or chest pain (possible symptoms of vertebral or rib fracture) that may occur with long-term therapy.
• Tell dentist or new physician about prednisone therapy.
• Carry medical information at all times. It needs to indicate medical diagnosis, medication(s), physician's name(s), address(es), and telephone number(s).

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug